Candace Therese Mezetin, MS,OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

014886 Issued in NY

Practice address

9745 Queens Blvd Ste 900
Rego Park, NY 11374-2108

Phone

(718) 830-9274

Fax

(718) 830-9276

NPI assigned

Nov 12, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226448000000",
    "number": "1740434190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10826 173RD ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114333034",
            "telephone_number": "347-724-0439",
            "fax_number": "718-657-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9745 QUEENS BLVD STE 900",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742108",
            "telephone_number": "718-830-9274",
            "fax_number": "718-830-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEZETIN",
        "first_name": "CANDACE",
        "middle_name": "THERESE",
        "name_prefix": "Mrs.",
        "credential": "MS,OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-12",
        "last_updated": "2008-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "014886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Occupational Therapist in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Pediatric Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.